US20040234453A1 - Geometrically shaped coupling hydrogel standoffs for high intensity focused ultrasound - Google Patents

Geometrically shaped coupling hydrogel standoffs for high intensity focused ultrasound Download PDF

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Publication number
US20040234453A1
US20040234453A1 US10/847,232 US84723204A US2004234453A1 US 20040234453 A1 US20040234453 A1 US 20040234453A1 US 84723204 A US84723204 A US 84723204A US 2004234453 A1 US2004234453 A1 US 2004234453A1
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United States
Prior art keywords
standoff
hydrogel
high intensity
ultrasound
polymer
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Abandoned
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US10/847,232
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English (en)
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Larry Smith
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UST Inc
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UST Inc
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Assigned to UST INC. reassignment UST INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: SMITH, LARRY L.
Publication of US20040234453A1 publication Critical patent/US20040234453A1/en
Abandoned legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A61N7/02—Localised ultrasound hyperthermia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/225—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves
    • A61B17/2251—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves characterised by coupling elements between the apparatus, e.g. shock wave apparatus or locating means, and the patient, e.g. details of bags, pressure control of bag on patient
    • A61B2017/2253—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves characterised by coupling elements between the apparatus, e.g. shock wave apparatus or locating means, and the patient, e.g. details of bags, pressure control of bag on patient using a coupling gel or liquid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/42—Details of probe positioning or probe attachment to the patient
    • A61B8/4272—Details of probe positioning or probe attachment to the patient involving the acoustic interface between the transducer and the tissue
    • A61B8/4281—Details of probe positioning or probe attachment to the patient involving the acoustic interface between the transducer and the tissue characterised by sound-transmitting media or devices for coupling the transducer to the tissue

Definitions

  • the present invention is directed to ultrasound coupling devices and, in particular, to geometrically shaped coupling standoffs consisting of hydrogels for use with high intensity ultrasound.
  • High Intensity Focused Ultrasound has been reported by many as a means of destroying tissue by thermal means, whereby, the tissue is heated to a temperature that denatures the cell proteins and by mechanical means through disruption of cellular and nuclear membranes caused by localized cavitation.
  • Others have reported the potential for HIFU to rapidly introduce hemostasis (the coagulation of blood and termination of bleeding) during surgery.
  • the energy requirements for HIFU to cause the therapeutic effects of hemostasis and ablation are on the order of 1,000 to 10,000 Watts/cm 2 .
  • the ultrasound energy most useful for establishing hemostasis and ablation with HIFU is in the frequency range of 2-9 MHz, which attenuates quickly in most solid materials including metals and plastics.
  • One technology for producing high intensity zones useful for hemostasis and ablation is to focus ultrasound energy by means of a lens or curved piezoelectric element.
  • This technique of focusing HIFU requires a coupling medium, typically solid or liquid, between the piezoelectric transducer and the target tissue with sufficient length (typically 1 to 6 cm) to support the transfer of the ultrasound to develop the necessary spatial peak intensity.
  • a coupling member is an important component of a HIFU surgical device for reasons that include:
  • focal zone is positioned either at the surface of the distal tip of the coupling member (which contacts the tissue or blood vessel) or beyond the tip at a deeper location in the tissue.
  • a coupling member possesses characteristics that include:
  • Water meets all the desired acoustic properties required by a coupling member including the requirement of low attenuation and in vivo biocompatibility. Water is however, difficult to contain in a manner that permits use as a coupling member for a HIFU surgical tool; whereby, the containment method does not in itself alter or negate the desirable characteristics of the water or rupture and cause the device to fail during use with subsequent difficulty in replacing the water coupling member.
  • HIFU coupling cones are robust and have been reported to address the containment problems of water in the construction of HIFU coupling members. Their disadvantages are high manufacturing cost, and high acoustic attenuation and impedance, which results in low energy transfer and the generation of unacceptable amounts of heat in the device.
  • Hydrogels offer an attractive combination of the desirable acoustic properties approaching water, as they may be comprised of greater than 60% water, and the advantage of a solid material that does not have the containment problems of water. They are typically moldable, inexpensive to produce and can be quickly changed during a surgical procedure.
  • Hydrogels have been used as coupling members and specifically as HIFU coupling members.
  • hydrogels previously investigated as coupling members were not suitable for use during surgery due to issues of in vivo biocompatibilty and/or lack of mechanical strength and resistance to HIFU degradation.
  • polyacrylamide PA
  • PA polyacrylamide
  • polyacrylamide is not an acceptable polymer due to the potential presence of neurotoxic acrylamide monomer in the hydrogel.
  • Acoustic coupling hydrogel standoffs produced from poly (2-hydroxyethylmetacrylate) or pHEMA have been found unsuitable due to their brittle nature and high attenuation, which is also true of hydrogels produced from natural polysaccharides and their derivatives.
  • the device of this invention relates to an in vivo biocompatible hydrogel acoustic coupling standoff for transfer of high intensity ultrasound to achieve hemostasis and ablation during surgery. More specifically, this invention relates to the discovery that a group of hydrogels, based on hydrophilic block co-polymers, one of which is polyacrylonitrile, can form rigid, low acoustic attenuation coupling members and are in vivo biocompatible.
  • inventive devices consist of hydrogel formulations having mechanical and acoustic properties such that ultrasound coupling standoff members of various dimensions and structural configurations such as cones can function as efficient ultrasound transmission media and devices within which the high intensity ultrasound beam can be coupled between the acoustic energy source to a focal point at or in proximity to the standoff terminus.
  • Hydrogel formulations, design and fabrication methods are described for production of ultrasound and energy transmission elements as the device of this invention.
  • FIG. 1 illustrates a preferred embodiment comprising a geometrically shaped coupling hydrogel standoff in the shape of a cone.
  • FIG. 2 illustrates the geometrically shaped acoustic coupling hydrogel standoff of FIG. 1 whereby the acoustic coupling member is contained within a external retention capsule which is attached to a transducer housing.
  • hydrogels that possess the acoustic, mechanical and structural properties required to function as ultrasound coupling and transmission media as is used in high intensity focused ultrasound (HIFU) applications such as hemostasis and ablation during surgery.
  • the present invention is preferably directed to geometrically shaped HIFU coupling members that are suitable for acoustic hemostasis and ablation within the human body.
  • the coupling members exhibit properties that include:
  • hydrogels for coupling elements were based on polymer in vivo biocompatibility with subsequent evaluation of conformance to mechanical and acoustic property requirements necessary to form and function.
  • High intensity focused ultrasound (HIFU) utilizes high frequency sound, typically between 2 and 9 MHz. Acoustic energy at such frequencies is poorly transmitted by air and requires an acoustic coupling member, typically a solid or liquid, between the transducer and the tissue. Acoustic coupling media have commonly been fluids, gels, or solids to efficiently transfer the acoustic energy between the HIFU applicator and the target tissue.
  • HIFU high intensity focused ultrasound
  • the inventive hydrogel acoustic coupling element operates as a geometric standoff between the transducer and the object of therapy and overcomes the limitations and deficiencies of the inventive devices of Martin et al.
  • the high frequency acoustic energy is concentrated into a small volume (typically in the shape of a grain of rice 7-10 mm in length) and at high intensity (typically over 1,000 watts/cm 2 ).
  • the hydrogels thus used for such ultrasound energy transmission must provide low levels of attenuation to limit heating within the coupling element, and efficiently transfer the energy to the treatment site.
  • the hydrogel thus used must also be thermally robust at the HIFU acoustic intensities, be in vivo biocompatible, relatively inexpensive, sterilizable and moldable into various geometries, such as cones.
  • the most preferred family of polymers are polyacrylonitrile block co-polymers that are sequenced with hydrophobic nitrile blocks in series with attached hydrophilic units that function as reaction sites.
  • the polyacrylonitrile co-polymer used in the device of this invention produces cohesive strengths that approximate the energy levels of covalent, cross-linked hydrogels. These attributes produce hydrogels with acceptable toughness, tensile, elongation, and tear strength properties.
  • This family of block co-polymers can be formulated so as to provide water or saline contents ranging from about 70% to about 95%. Presence of water or saline in the structure at these levels of concentration, provide an acceptable low levels of attenuation as is required for efficient energy transfer.
  • the polyacrylonitrile copolymers melt at temperatures in excess of 150° C. and thus provide thermal stability at operating temperatures that can reach 100° C.
  • the polymers of the preferred embodiment are hydrophilic acrylic acid derived block co-polymers such as those described in U.S. Pat. No. 5,252,692 to Lovy et al. and 6,232,406 to Stoy.
  • the most preferred polymer is based on a family of hydrophilic acrylate derivatives which as a molecule is structured such that a backbone of hydrophobic polyacrylonitrile groups are sequenced with a series of attached hydrophilic units that function as reaction sites.
  • the size of the nitrile groups and variability of the hydrophilic side groups provide opportunities to tailor the polymer to produce mechanical properties that are optimum for various applications.
  • the device of an embodiment of this invention is an acoustic coupling hydrogel standoff 1 which is a solid free standing hydrogel coupling member requiring no restraint or alternatively held within a retainer 2 for secure attachment and intimate contact interface to the face of a transducer 3 and its housing 4 .
  • Hydrogel focus cones for HIFU applications which are the preferred embodiment, are produced from hydrophilic acrylic acid block co-polymers in the form of “pre-polymer” solutions being so composed as to contain polymer melted in solvents such dimethylsulfoxide, dimethylformamide and water solution containing 55% sodium thiocyanate. Solvent concentrations are typically present in amounts of up to 55% with 2% to 35% block co-polymer, preferably about 5% to about 12% and most preferably about 8% to about 12%, comprising the above mentioned acrylate derivatives, nitrile groups and hydrophilic side groups. Such polymer solutions are known and commercially available.
  • Manufacture of the inventive hydrogel focus cones is most efficiently accomplished by casting the pre-polymer into molds prepared from porous ceramics, chemically compatible polymers and stainless steel. Alternatively, manufacturing can take the form of dipping, rotational casting or extrusion. Hydrogels of this family are formed by replacement of the polymer solvent during coagulation in water. Water solvates the soft blocks of the polymer and precipitates the hard hydrophobic blocks thus forming a new phase, which results in solidification of the polymer.
  • the acoustic coupling devices of this invention are preferably cast into porous molds as an 8-15% solution of the copolymer in aqueous 55% sodium thiocyanate. Prevention of gas bubbles in the finished coupling element is important to transmission without attenuation or scattering of acoustic energy through the hydrogel focus element.
  • the solution can be sealed under a nitrogen gas blanket, heated to 55° C. and held at constant temperature for 8 hours prior to casting. This solution can then be drawn into a syringe or production device suitable for bottom up filling of the mold to exclude formation of macro bubbles. The filled molds are allowed to stand for sufficient time to allow any entrapped air to rise to the surface of the polymer or casting vent.
  • a solvent in this case preferably sodium thiocyanate, or DMSO or dimethylformamide
  • solvents must be removed or extracted to permit formation of the desired hydrogel structure.
  • This process of extraction is accomplished by submersion of a water porous mold and its contents into a water, or saline (0.45% to 0.9% NaCl) bath at 45° C. followed by continuous rinsing with water until the solvent is removed and coagulation is complete. Completion time of solvent extraction and complete coagulation of the polymer solution is influenced by the thickness of the casting, the temperature of the rinse water and the concentration of the polymer solvent in the bath.
  • the coupling element castings are coagulated by rinsing in water or, preferably, saline (0.45% to 0.9% NaCl), with repeated changes of rinse water, until the rinse water contains only acceptably low trace amounts of the solvent such as NaSCN, which can be determined by conductivity testing.
  • the final dimensions of the cast hydrogel coupling elements can be adjusted by changes to the salinity of the final rinse and storage solution. As salinity is varied, mechanical properties and dimensions change. As the salinity of the storage solution is increased, the hydrogel shrinks dimensionally, and the tensile strength increases together with a decrease in elasticity. As the salinity is decreased the converse is true.
  • the acoustic coupling standoff members can be removed from the molds and further processed for packaging. Sterilization is best accomplished by E-beam (electron beam), or gamma radiation.
  • the cast hydrogel coupling elements such as cone shapes, are configured so that the base of the acoustic coupling element physically and intimately conforms to the contours of the transducer face.
  • the HIFU coupling members of this invention are secured to the transducer face so as to maintain a conformal and air free interface between the two.
  • Such conformal interface produces an acoustic coupling between the ultrasound transducer and the hydrogel HIFU coupling member, thus providing for the transmission of the ultrasound energy at or proximate to the site of device contact with tissue, blood or blood vessels.
  • hydrogel acoustic coupling standoffs when designed so as to incorporate use of acoustically transparent shells or containment devices, allow other polymers to become candidates.
  • Such acoustically transparent devices can function as molds in the casting process and/or as a retainer device when in use during therapy.
  • Polymers suitable for producing such modified hydrogel coupling standoffs by use of a retainer shell include hydrogels that form high viscosity gels and semi-solids, generally produced by covalent cross-linking or thru application of e-beam or gamma radiation, such as is in the case of high energy cross-linked PEO.
  • Potential candidate compounds are not limited to but include for example; cross linked polyvinylpyrrilodone, polyvinyl alcohol, chitosan, PVA/PAA, collagen, blends of collagen/poly (acrylic acid), collagen and poly (HEMA), PMMA, PDMS, EVAc, PLA, PGA, poly(anhydrides), albumin and polyesters.
  • the shape of the inventive acoustic standoff is not to be limited thereto.
  • Other shapes such as, for example, truncated cones, angular truncated cones, oval and oviform are contemplated by the present invention.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
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  • Surgical Instruments (AREA)
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EP1479412A1 (fr) 2004-11-24

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